Michael's Dispatches

An overview of harmful Army medical evacuation practices not endorsed by other service branches, and a response to official arguments defending this policy provided by the Joint Chiefs of Staff (JCS) to the House Armed Services Committee (HASC).

30 January 2012

Introduction

Michael Yon is a combat writer, and a former member of the US Army Special Forces. The New York Times noted in 2008 that he’d spent more time embedded with combat units than any other journalist in Iraq, and the reporting on his blog won the Weblog Award in 2005, 2007, and 2008. It is probable that he has also spent more time with combat troops in Afghanistan than any writer, photographer, or journalist of any sort. He is widely respected inside the military and beyond for the quality of his journalism, and his pursuit of the truth alongside US and allied combat personnel in the most dangerous theaters of operation.

On 18 September 2011, Mr. Yon accompanied an element of the US Army’s 1st Infantry Division, the 4-4 Cav, on a nighttime combat operation in Kandahar Province, Afghanistan. During this mission the unit was attacked with an Improvised Explosive Device, deafening one soldier, and amputating both legs and one arm of a second—Specialist Chazray Clark. Specialist Clark was conscious and communicating up until the time he was evacuated.

US and allied forces have two primary helicopter medical evacuation (MEDEVAC) assets in Kandahar: US Army “Dustoff” flights, and US Air Force “Pedro” flights. Unlike Army Dustoff flights, the Pedro flights—as well as British, Dutch, US Marines, Navy, and US Special Operations Command (SOCOM) medical flights—do not bear the Red Cross. The core reasons for this difference involve rapid reaction and maximum flexibility with limited air assets.

While Pedro, SOCOM, and Marine rescue flights can launch and insert quickly due to being armed, US Army Dustoff flights—following Geneva Conventions requirements for bearing the Red Cross—are unarmed, with Army policy requiring armed escort before they are allowed to launch their rescue missions. Consequently, unlike other MEDEVAC/CASEVAC flights, Army Dustoff flights are regularly delayed while they await escort gunships, often from other areas. There is no obligation under the Geneva Conventions to wear the Red Cross.

Specialist Clark and others probably died because of this delay.

During the incident in question, a Dustoff helicopter was approximately three minutes away, parked at Forward Operating Base Pasab. Both Dustoff and Pedro aircrews report being able to be airborne within roughly six minutes of receipt of orders.

However, because there were no Apache gunships available, the Dustoff flight for Specialist Clark was delayed. Official records state that he was delivered to hospital facilities 59 minutes after the MEDEVAC flight was requested by his unit—one minute from falling outside DoD standards, and within the “Golden Hour” from the moment of injury. But the military deceives here. Their fictitious Golden Hour does not begin at the moment of injury, but from the time the 9-line casualty report is received. This deadly deception was revealed in Golden Seconds.

Pedro helicopters also sitting at Kandahar Airfield could have completed this mission in less than 35 minutes. If Pedro or armed Dustoff had been stationed at Pasab, Chazray Clark could have been delivered to the trauma center in roughly 24 minutes.

The official record states that it took 59 minutes to deliver Chazray Clark to the combat support hospital. Video shot by Michael Yon provides conclusive proof that the military has deceived the Congress. Patient delivery took about 66 minutes from the time of injury, and about 65 minutes from the time of first report. There is no argument on this point. This clear deception brings in question all other military statements on this issue.

The death of Specialist Clark attributed to these delays is not an isolated incident.

The purpose of the Red Cross on Dustoff aircraft is to officially designate non-combatant status, granting immunity from hostile fire. Like many 20th Century rules of war, they are simply not recognized by any hostile elements the US is currently in conflict with. Even if they were recognized, the Red Cross is hard to see at night or during limited visibility. Helicopters do get hit with fire at night. For instance, a CH-47 was shot down at night last August, killing all 38 aboard.

According to the Geneva Conventions, "If there is no agreement, belligerents will only be able to use medical aircraft at their own risk and peril."

The reality is that helicopters bearing the Red Cross receive no protections, they are banned from participating in other high-need combat missions, and they have been delayed in their official duties to the point of permitting the deaths of US personnel.

It is also worth noting that because Geneva protections were not being afforded to clearly designated US Army Medics, they were ordered to cease wearing the Red Cross-marked armbands and helmets and to start carrying weapons—back in Vietnam. They have not worn them since.

Air Force, SOCOM, Marines, Navy, British and Dutch aircraft have foregone the Red Cross and its legal restrictions, resulting in vastly more flexible MEDEVAC capacity. In addition to being better positioned to save lives, it is notable that these units also maximize the dollar-value to DoD and the US taxpayer by maximizing the utility of the airframes and aircrews involved.

The senseless additional trauma inflicted upon Specialist Clark after the IED by faulty Army MEDEVAC policy was witnessed by Mr. Yon, and in further researching and reporting on the incident, the full scope of the poor judgment involved in these MEDEVAC policies came forth. Many seasoned professionals of all walks, including dozens of aircrew members of different service branches, reached out to him to provide further insight. Dustoff crews, in particular, expressed deep frustration with these policies.

Of additional tremendous concern coming to light is that current Army Dustoff policies actually violate Chapter VI of the 1949 Geneva Conventions, to which the US is a signatory:

“Article 36. Medical aircraft, that is to say, aircraft exclusively employed for the removal of wounded and sick and for the transport of medical personnel and equipment, shall not be attacked, but shall be respected by the belligerents, while flying at heights, times and on routes specifically agreed upon between the belligerents concerned.

They shall bear, clearly marked, the distinctive emblem prescribed in Article 38, together with their national colours on their lower, upper and lateral surfaces. They shall be provided with any other markings or means of identification that may be agreed upon between the belligerents upon the outbreak or during the course of hostilities”

Medical aircraft shall obey every summons to land. In the event of a landing thus imposed, the aircraft with its occupants may continue its flight after examination, if any.” (Underscore emphasis added)

The reporting of this incident and calls for a change in Army MEDEVAC policy resulted in significant pushback from Army authorities in-theater. Congressional interest and inquiry resulted only in further resistance from military authorities, including at CENTCOM, all the way to the highest levels of Pentagon military leadership—the Secretary of the Army and the office of the Joint Chiefs of Staff.

It is the opinion of Mr. Yon and many of his readers who are subject matter experts, that documentation provided to Members of Congress and the House Armed Services Committee (HASC) regarding Army MEDEVAC policy contains falsehoods and is obfuscatory in nature.

In particular, the office of the Joint Chiefs of Staff provided HASC an unsigned document with neither title page nor date, which was riddled with egregious errors and deceptions. With this document, JCS deceived Congress. While the author is unknown, and may have come from lower commands, the document was provided to HASC by JCS under the color of their authority, without caveat.

The remaining portion of this article addresses this document, and sheds light on the reality on the ground as our troops experience it. Of particular note, thirteen active duty helicopter pilots contributed to this analysis of the JCS document—five Army Dustoff, five Air Force Pedro, and three additional non-Dustoff Army. All have completed at least one tour in Afghanistan, or are there now. Many have also completed combat tours in Iraq. In total, these 13 pilots have roughly 25 combat tours between them, and thousands of missions. More than twenty subject matter experts contributed to this analysis.

“The information below details the circumstances surrounding the event in question as first reported by Michael Yon in his blog titled ‘Red Air’ and followed up by an open letter to Secretary Panetta and President Obama.

After examining the facts and circumstances of this particular incident and compiling data regarding all MEDEVAC/CASEVAC missions in theater, we have found no merit to Mr. Yon's claims that any change in MEDEVAC policy or procedures would provide any improvement in current casualty survival rates.”

Mr. Yon: Both the White House and Pentagon were offered copies of the original, unedited video of the attack in which Specialist Chazray Clark was wounded, described in “RED AIR”, which extended over an hour and included the long delay of the Dustoff arrival. Neither the Pentagon nor the White House accepted the video, nor have they accepted argument from MEDEVAC crews, and aircrews from other services regarding the speed and effectiveness with which they can conduct rescue operations without the Red Cross designation. The edited, public version of the video may be found here.

According to JCS:

“Below are definitions that are useful and commonly used when discussing MEDEVAC procedures:

MEDEVAC- Unarmed, specifically designated (Red Cross), US Army UH-60s CASEVAC- Any evacuation asset other than MEDEVAC (CH-47, UH-1, UH-60, etc.), may be armed or unarmed.PEDRO- Air Force HH-60 armed with.50 caliber guns on both doors; primary mission is personnel recovery/CSAR; in RC-South, only located at KAF”

Mr. Yon: Pedro units are stationed not only at KAF (Kandahar Airfield), but at Bastion and Bagram as well. (In other Regional Commands.) More importantly, however, while their primary mission might be stated as “personnel recovery/CSAR”, the reality is that they are doing MEDEVAC/CASEVAC daily, and even patient transfers in other areas. Argument has been made that Pedro assets are limited strictly to special operations-types of rescues. This is not the reality of their employment in-theater.

Mr. Yon: No “.240 caliber” weapons exist in the US inventory. This is such a conspicuous error that the author simply cannot have had any experience with combat units. Within a combat unit, this is as glaring as saying, “The Houston Red Sox won the Super Bowl. It was a great soccer match.” Perhaps the author was interpreting this from the M240 machine gun, chambered for the 7.62mm cartridge. Further discrediting the author was a note I received from a Dustoff pilot currently in Afghanistan, stating that most Chase flights in Afghanistan are “MED on MED chase,” and are thus unarmed.

Mr. Yon: This is false—Pedro aircraft do perform escort. Pedros are well armed with two .50 caliber machine guns per aircraft. It is suspected that this duplicitous definition is an attempt to discredit or minimize the policy of other services to provide medical flights that are self-escorted, as Pedro flights are.

JCS:

“Category A (Cat A) - urgent case requiring evacuation within 60 minutesCategory B (Cat B) - evacuation required within 4 hoursCategory C (Cat C) - evacuation required within 24 hoursFirst Up (1st up)- Primary flight asset with responsibility to be first to respond; generally assumed to have 15 minute "run up" timeSecond up (2nd up)- Back up flight asset generally responding only after 1" 1 up is unavailable (on mission, mechanical failure, etc)Run up -The time it takes to prepare an aircraft to fly; generally considered 15 minutes (some aircraft/crew take less time, some take more)”9 line MEDEVAC Request- 9 lines of information requesting the evacuation (location, number and severity of injuries, condition of landing zone etc...)”

Mr. Yon: The assertion of 15-minute run-up times is inaccurate, and is likely being used to pad “acceptable” time into the delayed response in Specialist Clark’s MEDEVAC, and others. Pedro and Dustoff crews need about six minutes to be airborne. British MERT uses a larger helicopter and brings a surgical team and can take fifteen minutes during daytime, but up to thirty minutes at night.

JCS:

“Summary of events in response to ‘Red Air’.

The Combined Joint Task Force (CJTF) 82 decision matrix on MEDEVAC asset allocation is similar to that of the previous battlespace owner, CJTF-10, in that a dividing line exists whereby those missions falling to the west would be assigned to the MEDEVAC assets based at Forward Operating Base (FOB) Pasab and those falling to the east would be assigned to the assets based at Kandahar Air Field (KAF). While similar decision points exist for the MEDEVAC assets at FOB Sakari Karez, Tarin Kowt, and Wolverine, only the previously described line was relevant as the casualty of reference was between Pasab and KAF. The Patient Evacuation Coordination Cell (PECC) in RC-South has the decision lines plotted to assist with rapid evaluation in assigning the evacuation to the location with the most expedient route to the appropriate military treatment facility (MTF).

Based on run-up times and distance from the appropriate MTF's, CJTF-82 determined that the MEDEVAC is the only appropriate asset for any Category A casualty found west of the dividing line; Pedro, from KAF, will only be used for the much less urgent Category B (if PEDRO is first up) or Category C (if Thunder is first up). Those casualties to the east of the dividing line will be assigned to MEDEVAC or PEDRO based on which unit is first up and which is second up; the designation of which is alternated each Monday at 1300.”

Mr. Yon: The tone of this passage seems designed to appeal to authority and dazzle with vocabulary, but consistently, Pedro and Dustoff pilots report slow, weak, or poor decision-making processes coming from PECC. Reports indicate this is a major problem with the medical evacuation system in Afghanistan. A common complaint from pilots is that PECC will task aircrews in a way that makes little or no sense, including having a Dustoff or Pedro flight sitting “hot cocked” (ready to go), only to task a unit needing far longer to spin up, such as the excellent but slower British MERT (Medical Emergency Response Team).

Army and Air Force pilots insist the decision on who to send is often tactically senseless. The worst examples involve using Pedro units—possessing the highest and most advanced rescue capability—on routine Cat-B or Cat-C patient transfers. Mr. Yon accompanied such missions with Pedro. It is fairly mindboggling to witness a Pedro flight used for routine medical transfers—it’s the equivalent of using a SWAT team to write parking tickets, being taken out of availability along with the most advanced gear. Pedro HH-60G Pave Hawks are capable of entering very hot Landing Zones on the most dangerous or technically difficult of missions and terrain, on missions that may involve the most severe weather, heavy enemy forces, or require scuba (our vehicles are sometimes blown into rivers), or requirements where the medics may have to climb or parachute to patients. Dustoff cannot perform all Pedro missions, but Pedro can perform all Dustoff missions, and more. Pedro should be reserved for Cat A and very dangerous or technical work. Had this policy been in place for Specialist Clark, he may have lived.

As one Pedro pilot noted: “[This is a] serious problem—our aircraft were never intended to fly as much as they have had to. It is like owning a car with over 400,000 miles that you have to use as a daily driver. Our maintenance folks are killing themselves trying to keep them flying.”

A second Pedro pilot noted: “Pedro is limited in performance due to weight from mission equipment on high altitude missions in hot temps. We have HC-130s [Fixed-wing aircraft] in country and can still do a Jump Mission with the PJs to get medical care to them within the Golden Hour then call a Chinook for extraction. Which the PECC would probably never think of.

This is the critical problem with the entire system. ISAF PECC Qualifications are inadequate for the Medical Evacuation Personnel assigned. They make the recommendations on which asset to use to the officer in charge of the JOC [Joint Operations Center] who then authorizes it. The personnel who fill these positions try hard but are simply not qualified. Many are Non-U.S. Forces and come from other ISAF Nations. The only folks running Medical Evacuations in Afghanistan are American and British. Last time I was there and went to the PECC at Kandahar to see for myself who was making these decisions I was surprised to see for myself that it was a Medical NCO with clinical but no evacuation experience. Medical personnel run system not Personnel Recovery folks. They simply don’t know anything about tactical operations. They spend a lot of time thinking about what is the right thing to do rather than instinctively knowing what to do immediately.

This position should be filled by a Guardian Angel Combat Rescue Officer or Pararescueman, Pedro, Dustoff, or MERT pilot or crewmember that has completed at least one operational tour. We need someone making the recommendations to the officer in charge that actually knows what he is talking about.”

According to the JCS document:

“MEDEVAC's will require an ESCORT if the casualty is in a area designated high risk landing zone, "hot LZ" by the 9 line request. This is accomplished by the PECC alerting the supporting aviation brigade who then scans the airspace to locate the closest appropriate asset able to divert and provide coverage in to the high risk area. In most cases, an appropriate asset is already in the air and can quickly divert to cover the mission; however, if no flying asset is readily available due to mission necessity, an ESCORT will need to be requested from KAF. The latter is the least preferred as it will take more time to scramble the crew and "run up" the aircraft.”

Mr. Yon: This entire passage would be made largely irrelevant were Dustoff MEDEVACs armed. In all but the most extreme cases—where Pedro units would be best tasked—Dustoffs simply would not need escort if they had their own weapons. Pedro is armed and requires no additional escort. Escort requirements cause delays, and further stress already stretched rotary assets.

JCS:

“The incident in question involved a casualty at approximately 0450 on 18 September 2011 in the TF Spartan AOR in RC-South. Since the near entirety of TF Spartan's battlespace is west of the dividing line, the appropriate aircraft for any CAT A casualty in this AO is a MEDEVAC. In this case, because the western LZ was considered high-risk the MEDEVAC required an armed escort. Because none of the airborne assets were able to leave their mission to provide coverage an AH-64 was requested from KAF. The crew was scrambled and the aircraft was "run up" and launched toward Pasab; the MEDEVAC from Pasab then joined the ESCORT in the air as it approached the objective.

Timeline:

a. 04:50 – 9-line request placed by unit in fieldb. 04:52 – Time of PECC authorization (and begin tasking for ESCORT)c. 05:24 – Wheels up for MEDEVAC from Pasabd. 05:37 – Wheels down for MEDEVAC at Casualtye. 05:39 – Wheels up with Casualtyf. 05:49 – Wheels down at MTF (KAF)”

Mr. Yon: Had the Dustoff stationed at Pasab been armed, the seven-minute run-up time and roughly three minute flight time from Pasab to the Landing Zone (LZ), plus a combat-realistic 2 – 3 minute loading time, would have meant Specialist Clark would have been airborne to the Combat Support Hospital at Kandahar Airfield within fifteen minutes of his unit calling in the 9-line request.

Instead, roughly half an hour was wasted in waiting for an escort, along with additional minutes in linking up with the AH-64 escort.

According to JCS:

“The only stated time goal for MEDEVAC is the 60 minute "golden hour" from time of 9- line request to wheels down at the MTF. This mission was documented at 59 minutes. The 60 minutes is derived from a combination of assuming it takes 15 minutes to "run up" the aircraft, 40 minutes to fly from the base-point of injury-MTF, and 5 minutes for casualty load time; however, this breakdown is only based on estimates and there is no rule that each specific subset must be met.”

Mr. Yon: This passage is a stunning argument for mediocrity, and shamelessly uses poor policy to provide cover for poor decision-making. Given the circumstances and available assets, Specialist Clark should have been at the hospital within half an hour, maximum. This letter argues a fictitious 59-minute timeline, in addition to ignoring the minutes it took Specialist Clark’s leadership to determine, in the dark in a combat environment, the nature of the blast and casualties, and to call in the proper information in the required 9-line format.

JCS:

“The extenuating circumstances in this case were the need for an ESCORT and the atypical situation where an ESCORT capable of diverting from its current mission could not be found. This circumstance delayed the MEDEVAC from departing Pasab and required an AH-64 ESCORT to be alerted from KAF. While it would appear that 32 minutes from the PECC notification to wheels up for the MEDEVAC is excessive, the delay was due to the need to confirm that none of the ESCORTs in the air were able to leave their present mission and then to notify an AH-64 crew to move out to their aircraft, run it up, and fly to meet the MEDEVAC.

Mr. Yon's allegation is that the PEDRO would have been more appropriate in this situation. There is no substantiating evidence for this claim. In hindsight, it might have been possible to transport this casualty to the MTF more quickly if the PEDRO would have been launched at the exact time of notification for this mission but that would only have been possible with the foreknowledge of no available local ESCORT.”

Mr. Yon: The mendacity (or ignorance) of this argument is made clear by this Pedro pilot: “Does not make sense. Why would there be no operational knowledge of which tactical assets were available for tasking? Pedro was either first up or second up. If Dustoff was first up but had no escort, immediately send the second up, Pedro. Pedro goes either way. [This is a] leadership failure— there is a system in place, and they should know which assets are available. I knew when I was in Command of the Pedros who else was available besides us; there is no excuse for this.”

JCS:

“However, once the time had been taken to ascertain no active local ESCORTs were available, turning to the KAF-based PEDROs would not have decreased the mission time as the AH-64 and PEDRO would have similar preparation and flight times due to distance from the casualty.”

Mr. Yon: Again, the entirety of this argument would be irrelevant were the Red Cross removed, and Army MEDEVAC flights made by armed helicopters. Mission time would have been less than half of what it was. Critically, changing this policy also keeps those AH-64 Apaches on-station, on the combat missions they’re intended for, and protecting ground units.

JCS:

“If it is alleged that waiting for an armed ESCORT is an excessive delay it must be considered that to date, there have been only five escorted MEDEVACs that have encountered surface to air fire resulting in degraded operations, two of which were PEDRO helicopters.”

Mr. Yon: In light of the many counterfactual statements above, these numbers should be looked at with suspicion, especially considering that medical flights are not all qualitatively equal. It should be kept in mind that in August 2011, an ESCORTED helicopter was shot down during a combat operation, with 38 people being lost, including 22 Navy SEALs. This JCS red herring is discussed in detail in “Golden Seconds” . Importantly, Pedro units are far more frequently sent into far more dangerous situations than are Dustoff. Per capita, Pedro takes more fire.

JCS:

“Based on all the facts regarding this incident it is ISAF's contention that the MEDEVAC assets were properly managed according to well established protocol. Based on the information provided, the timeline appears reasonable for the conditions on the ground. The well established PECC procedures appear to have been followed and the casualty arrived at the MTF within the established 60 minute goal in spite of being injured at a high risk location requiring an ESCORT aircraft.”

Mr. Yon: Medical professionals know that the Golden Hour starts ticking at the moment of injury, and adding in the requirements of assessment and reporting for Specialist Clark’s unit, the overall time was well over the “Golden Hour.” Importantly, we were taking no ground fire on the LZ. A more courageous and sensible decision by PECC would have been to launch Dustoff and let the pilot and ground commander decide on whether to complete extraction, or to wait for escort. Pedro and Dustoff pilots complain that PECC tends to be risk averse to the point that troops die.

A pilot with a tour in Iraq and a recent tour in Afghanistan was livid with the JCS document: “This ‘Golden Hour’ thing is, as you have pointed out, a flawed way of thinking about it. Why not make it a ‘Golden Half Hour,’ or a ‘Golden as soon as possible’? It is just a statistical construct. Each wounded American soldier must be looked at and cared for individually in terms of what is best for them. In most cases, that means getting them there fast. It makes a big difference. Believe me, if the leadership had their own sons in harm’s way as I have [his son is also a combat veteran], they would think much differently, and become totally committed as I have to fly as many as possible to the hospital as fast as possible.”

JCS:

“Theater-wide MEDEVAC Statistics

For the period May to Oct 11 there were 1209 Coalition Forces (ISAF and USFOR-A) CAT A missions of which 95 CAT A missions were Out of Standard (OOS), meaning they exceeded the 60 minute Golden Hour planning factor. This equates to 7.86% of CAT A MEDEVAC missions that were OOS. There are several factors that can cause a mission to become OOS, including weather, mechanical, distance, enemy situation and waiting for air weapons team (AWT). Of the 95 OOS CAT A missions from May-Oct 11, seven were categorized as being a result of waiting for an AWT and none of these seven OOS missions had a clinical impact on the casualty.”

Mr. Yon: Considering Specialist Clark was alert and talking up until the point of being evacuated, but succumbed shortly thereafter, it’s fairly outrageous to read a claim that says nobody experienced “clinical impact” from these delays. This short timeframe and the attempt at wielding statistics to cover poor policy and judgment only adds to this outrage. Essentially, this document argues for a Military Golden Hour to be treated as a “pass all.” By self-scoring, if no more than 59 minutes of the debatable Golden Hour are used, they get a 100%. How many more wounded veterans would have died if evacuations were delayed by an additional forty minutes? According to iCasualties.org, 46,542 US troops (not to mention contractors and allies) have been wounded in Iraq and Afghanistan. If an additional 40 minutes were added to each before they reached a hospital, how many more would have died? One percent? Two percent? That’s anywhere from 465 – 931 additional dead.

“The overall trend line for OOS missions is decreasing over time. In 2010, 11.8% of the total CAT A missions were OOS compared to 7.86% OOS from year to date.

In the last six months, there have been a total of 57 surface to air fire events involving MEDEVAC aircraft. Of the 57, none resulted in aircraft being shot down. Five resulted in hits which degraded operations, including one British ‘Tricky’ CH-47, two US Army ‘Dustoff'HH-60s, and two US Air Force ‘Pedro’ HH-60s.”

Mr. Yon: Is this for the entirety of Afghanistan, or just Regional Command South? Importantly, the JCS admit here that the Red Crosses do not stop the enemy from shooting at Dustoff. We’ve seen too many faulty numbers and statements in the JCS document. None of the numbers can be trusted.

JCS:

“Summary

The MEDEVAC circumstances surrounding the specific incident highlighted in Michael Yon's ‘Red Air’ did not contribute to the untimely death of a brave Soldier who suffered a triple amputation due to an IED strike. Removing Red Cross from Army ‘Dustoff' helicopters will not improve the exceptional MEDEVAC capability already in place. Not only is there a policy implication with making such a decision but more importantly an operational impact which actually may degrade current MEDEVAC capability.”

Mr. Yon: This note from a former Ranger and Green Beret, who is also a combat veteran, clarifies the obfuscation: "Not one point that they have made in their letter supports the above contentions. They have written a letter and included arguments and made points, but not for the ‘conclusions’ above. It is as though the Chiefs wrote a different letter and then omitted all discussion of the Red Cross, not to mention ‘policy implications’ (and what does that mean?), not to mention their reference to ‘an operational impact.’ The Chiefs have not explained their nebulous ‘policy implications’ or their reference to potential ‘degraded capabilities’ or their reference to ‘operational impact,’ whatever that actually means. More artful public affairs sleight of hand. The Chiefs obviously think that we are stupid."

JCS:

“The primary mission of Pedro helicopters are for Personnel Recovery and Combat Search and Rescue. Pedro's in the Afghanistan theater are routinely integrated into the MEDEVAC rotation to maintain crew and medic proficiency. Because of advanced avionics and other organic armament and weaponry, the Pedro is rated as being able to only carry two litters at a time, compared to the Army Dustoff which is rated as being able to carry four litters at a time. The extreme altitude and often unpredictable weather conditions in Afghanistan make the weight of a helicopter a critical planning factor in being able to conduct flight operations.

Mr. Yon: A Dustoff pilot currently in Afghanistan disagrees. JCS states that four litters can go, but according to the Dustoff pilot, the Dustoff can carry four litters only “if carousel litter carriers are installed, in which case we would be power limited because the stupid things weigh over 500 pounds and make it impossible to work on any part of a casualty but their head or feet. We don’t use carousels in Afghanistan. We strap litters to the floor, and three will fit but two will be ignored.

The Dustoff pilot says two patients will be ignored. Experienced combat medics will say that no matter how great the medic, he or she cannot work on three Cat A patients simultaneously. Dustoff carries one medic and so more than a single Cat A will just be strapped down for the flight.

A flight of one Dustoff and one Apache can treat just one Cat A patient.

By comparison, Pedro escorts Pedro. Each of the two Pedro HH-60G Pave Hawks carries two or three pararescue “PJ”s. (Often a total of five PJs between the two birds.) And so a normal flight of two Pedro Pave Hawks can work five Cat A patients. (There is some nuance depending on types of wounds, etc.)

As medics, PJs are well trained. They also receive rigorous combat training and can parachute to patients, mountaineer, and scuba dive, all of which can be needed in Afghanistan. PJs are trained to fight. In the case that a Special Forces (Green Beret) team medic is wounded in Afghanistan, at least one Pedro unit planned to leave a PJ or two behind to cover for the team while another medic could be found. When patients are trapped in twisted wreckage of armored vehicles, PJs have gear and training to cut into the vehicles. PJs are something of mixture (for argument’s sake) between Rangers and highly trained medical personnel. And so with a Dustoff flight, you get one medic whose mission often must wait for launch authority. Pedro brings four .50 caliber machineguns with dedicated gunners, along with five commandos (PJs) who can get off the birds. Dustoff is an air ambulance: Pedro is more of a special operations force.

Pedro pilots dismiss the weight argument. As one highly experienced Pedro pilot noted: “…I've had three litters back there…and if the survivors can sit up (ambulatory) you can quite literally pile them in. I haven't limited the aircraft yet over there. The considerations are patient care, time en route, aircraft performance (do I have the power to take off) and the ground threat…if I don't take the survivor now does he have the time to wait for the next trip? As a Flight Lead, I'll weigh all available info, and lean on the Pararescue Team Lead to determine how many. If it’s a mass casualty event, we'll triage the survivors and take the Cat A’s first and return for the B’s and C’s and lastly the Heroes [KIA]. But yesterday here at [training] I put 9 people in the back of one aircraft, and 9 in another, total of 18 bodies in two aircraft. They were all ambulatory and the ground threat was high so comfort went out the window. It was about getting their asses out.”

JCS:

“Arming a Dustoff helicopter, whose primary mission is MEDEVAC, would require approximately an extra 600 lbs. This is based on two door gunners, 200 lbs each; two .50 cal machine guns, 841bs each; plus conservatively estimating 100 lbs of ammunition. This extra weight would have a severe impact on lift capability and also limit the ability to evacuate four litters vs. two. This trade-off of lift to armament is unacceptable and would result in severely degrading MEDEVAC operations.

Mr. Yon: Combat experienced Dustoff and Pedro pilots address this:

Dustoff pilot: “The weight argument is crap. My platoon flies UH-60A+ aircraft (Alpha slicks with Lima model engines) chased by UH-60L with [M-240 machine guns] mounted. Our chase birds outweigh us by about 1000lbs. The HH-60L and M models weigh significantly more but still much less than the Pedros' birds.”

Pedro pilot: “Remember that arming 2 x Dustoff helicopters means no chase aircraft and allows you to use both aircraft as evacuation platforms. You have a greater capability not less.”

Dustoff pilot: “…The notion that 600 extra pounds would exclude us from carrying 4 litter patients is wrong. We have a ‘PPC’ (performance planning card) that we use to tell us exactly how much we can carry…I can guarantee the Lima and Alpha+ models can handle that no problem...in RC S/SW. In east and north the altitude starts to get much higher so I can't speak for that region as we do not fly there. Second carrying 4 Cat A litter patients would most likely mean there was a mass casualty, of which my unit has responded to at least [stricken for anonymity] and to my knowledge they were all local nationals …Apart from that my medics generally put one Cat A on board because they can only efficiently work on ONE patient at a time, especially in the Clark case, with a triple amputation that medic has his hands full. That's not to say we leave anybody behind but the most critical are treated first. Which is why we spread the patient load. The example of 4 Cat A just sounds like deflection when the real point of all of this is not to increase patient capacity but to get the wounded off the battlefield in the quickest manner possible. If need be we can take as many patients as will fit inside, but as one of my medics told me, it comes down to who he thinks has a chance as to who gets treated on the flight as the majority of our flights are less than 30 min. Like I said above if one aircraft HAS to take 4 litters there have already been calls made and at least three more hawks will be en route.”

Pedro Pilot: “The DUSTOFF aircraft I escorted as a Pedro [were faster than] me; they were much lighter than I was and had a large power reserve that I did not possess because of my extra weight in armaments. That being said, the Pedros record on being able to still execute the CASEVAC goes without question.”

Mr. Yon: These pilots find no merit in the weight argument.

JCS:

“In conclusion, the MEDEVAC system currently in place is truly a success story. This level of capability has never been delivered before and demonstrates the degree of commitment that is expended in supporting our US, NATO, ISAF and Afghan forces. While it is not a perfect system it is truly unprecedented and we should ensure any changes to the system is carefully examined and only done after a thorough evaluation in order to ensure our service members receive only the best care available.”

Former Ranger and Green Beret:“I am really tired of the Chiefs [congratulating] themselves over a ‘level of capability that has never been delivered before.’ So what? [They] send the best men in the nation to war, who go willingly, who volunteer. They deserve the best. They are not receiving the best now, and worse, they are not receiving the best now due to bureaucracy and parochialism and the egotistical protection of fiefdoms. The JCS should be ashamed of themselves.”

or post as a guest

You are fighting a losing battle trying to correct anything wrong with this present administration and their minions. They take credit for what good is done by our Military and then ignore the rest. They don't care if our men die uselessly...don't you get it? The game is rigged Mike...face it!!!

The game/fight may be rigged but there's no reason to take a fall, keep it up. The president and his butt boy Panetta take great credit for SEAL team successes but not for losses, they neglect to mention them except in amorphous references taking credit for reducing forces in war zones, bringing the boys home, and changing definitions of various organizations to make it seem there is more available than in actual head counts.

You're 100% right Mr. Clayson. No...I never give up but when one strategy doesn't work we need to reappraise the battlefield and maybe get a new strategy....or add to the one Mike has. I never knock Mike. I think he would tell you we have always been 100%, sometimes more, behind him. But this is a totally different type of battle that we are fighting here. Do you, Mr. Clayson, have any good ideas of how to beat the enemy within the country? And don't give me that tired old answer at the ballot box. You know how corrupt this next election is going to be don't you....or do you. All we get is lies and deception now...and totally being ignored as citizens. How would you combat that? Mike tells the truth but the truth is not being received in hight places where it should be welcome. What now Mr. Clayson. I'm willing to listen if you have real answers. And Mike...you know a&n have always been with you, good times and bad. But this is an enemy you haven't faced before and I question you to make you think...We need all the thinkers we can get!!

I have to disagree A&N..I think by Michael bringing this to light that something with have to be done. I cannot thank Michael enough for having the guts to be out there, life threatened, to show us all what the truth really is. God Bless Michael and I send my best to you. [quote name="A&N"]You are fighting a losing battle trying to correct anything wrong with this present administration and their minions. They take credit for what good is done by our Military and then ignore the rest. They don't care if our men die uselessly...don't you get it? The game is rigged Mike...face it!!![/quote]

[quote name="IronV"]Your thinly veiled political attack distracts from, and does a disservice to the real issue. This question predates the Obama administration by a considerable margin.[/quote]

This issue is not about politics........Though I get the distinct impression that you would like it to be.

Because this is an Army issue, a bad policy that has been embraced at the highest levels of the Pentagon, does that make an attempt to rectify it a "political attack?"

As you correctly point out, this policy has been in place through multiple presidencies. Are you aware that the Pentagon bureaucracy prefers to be left to itself to run itself with as little interference from the rest of the Executive branch as possible?

The Perfumed Princes at the apex of the Pentagon know better than you or I, you see. How dare we challenge their decisions?

This is how.

We reveal facts. We contact Congressmen and Senators. We write OP-EDs.

This controversy is so transparently wrong that I marvel at the Army's intransigence. On its surface, it is a matter of common sense. The only explanation for the refusal of the Army to change the policy is that one constituency, one faction within the Army, will lose assets to another. Or, the Army will be vulnerable to a power grab from the Air Force.

This is where the true politics of this matter reside. This has nothing to do with Mr. NObama. It has everything to do with the Army wanting to keep things as they are, and not wanting to upset somebody's apple cart.

How about we just do the right thing for the troops?

Why does it have to be more complicated than that?

Those bureaucrats and politicians in uniform who are fighting this battle with number 2 pencil lead in their cubicle bunkers need to be brought up on charges of treason and prosecuted.

Again, it appears that the people in charge have spent more time covering their own desk chair asses than in helping to solve the problems being pointed out and revealed by the actual combat teams. Washington orders the wars, the generals send in the men, and then cover their own butts. What's so new about this? Nothing. Bravo Michael for shouting this out to the world, and to the other combat vets who know the truth of that situation. You are all making a difference,, however slowly it might be being realized.

1) State there is no "Golden Hour" - death from wounds clusters bi-modally around 15 minutes and then between 60 and 240 minutes. This means the most seriously wounded will die before any MEDEVAC mission could possibly get them to aid, BUT the MEDEVAC goal should be between 15 and 45 minutes in order for doctors at a MTF to begin treating someone.2) The top cause of death is uncontrolled bleeding. In the case of SPC Clark there were solid tourniquets on each of the wounded limbs. Many other US troops have survived triple amputations and are now back home alive.3) The Army has also reported that the number of wounded taken on a single MEDEVAC flight is overwhelmingly one person very seldom exceeds two.

You should try fighting a war on the Mexican border with the Fed. Gov. supplying the enemy with weapons and sueing us for trying to defend ourselves. It's a trend Mike...can you see it? Tying the hands of our Military men and our civilians...denying them the weapons and equipment they need. Defending the enemies...They have forgotten who started these wars...and are refusing to defend our own country. This is not a Military problem. It is a political problem. These Military minions are saying what they know they are suppossed to say.....and if worse comes to worse and the American people say..."That's enough" then the generals can be the scapegoats. You aren't going far enough up the line of command Mike. We here in Arizona might not have our boots on the ground in Afghanistan but we seem to know how this government is working as well as you do because we have seen them at work.

I applaud your efforts and diligence with this problem Michael, it needs to be brought to light.I am sure that the root cause is that this is a "NATO effort" and as such is fraught with bureaucracy and it's inefficiency.NATO should have gone away starting in 1989 when we won the Cold War but instead has been a shield for Europe to hide behind for the last 20 years.

How could it be a fault of NATO? The Marine Corps and the Airforce doesn't fly with Red Crosses on unarmed MEDEVACs, and I'm pretty sure most NATO countries don't do it either. From what I can tell it's strictly an Army problem, with people not wanting to lose control of "their" helos to other branches of the Army as I think Mr Yon has mentioned. No good blaming NATO, it just puts the blame on someone else than the responible half officers, half politicians within the Army.

Michael, have you considered the perspective that the Airforce and the Marines have different regulations concerning "combat arms" assignments for female pilots? If the Army restructures its squadrons so that current ships designated for unarmed Medevac missions are armed, will they have to reassign female aircrews who are currently limited to non-combat flight status?

Is this a reasonable question? I'm not involved so my perspective is as an outsider, but I haven't seen this aspect in your writing on this topic.

The Army has female Apache. I have heard them on the radio. The Air Force has had female AC-130 pilots (for some time) as well as some fighter pilots. The Navy has female fighter pilots. One female Army Major was captured when her CH-47 went down in the first Gulf War. They may not going to be Infantry or SEALs, but their presence in Army Aviation is pretty secure.

People who link an administration or the “White House” or the President to a highly complex Army internal problem just do not understand government. If the President or the National Security Advisor were aware of this problem, they would still ask the military to explain what was going on and how we could improve the current “system.” On this blog, the best insights come from pilots who have flown the missions and “Battle NCOs” who have initially received the 9-line casualty evacuation request. Do you think that that level of understanding extends into the offices of the JCS? Even the Army itself would need to bring in similarly experienced and current personnel to correctly describe how the systems is working. So what do they do? They ignore evaluating and streamlining the system and, instead, launch an investigation to find a culpable individual whom thewy can pin the blame on. In my memory, if the Services are forced to address a problem; they will revert to pin the tail on the donkey. That’s what happened at Pearl Harbor; that’s what happened with the USS Pueblo, and that’s what’s happening now – an investigation.

What we have is the Army clinging to the idea that we are doing this the way we have always done it and it’s working – just look at our statistics. But that’s not true. The relevant sections of the Geneva Convention, drawn up in 1949; bear no resemnlance to the types of wars we have fought since. In fact, it doesn’t even work for WWII. Probably this is because the people who performed the job did not participate in drafting the document. Our current enemies cannot read, did not sign the document, and could care less.

It's been a while since I wore a uniform (Navy surgeon), but, the fundamental principle is 'scoop and run.' Stabilization in the field must be weighed against wasting time in the field since your best chance of survival is on the OR table ASAP. Some of my chiefs, with experience in Vietnam have told me that wounded were bundled into poncho and thrown on board to get that soldier to the surgeon.

In the case of sp Clark, we really don't or couldn't know the extent of injury in the field. How close was he to the ied? What are the over pressures? What other bleeding other than the three limbs? If he was to survive, you had to get him to the surgeon.

If you want a sound bite it is, again, 'scoop and run.' This is the point that needs to be driven home; to hell with Geneva. (The Geneva will never have any weight with 'the religion of peace.') Scoop and run was a principle learned in Vietnam and has filtered into every trauma ER since. That point is the one that need to be repeated over and over again. A point that will be backed by any trauma surgeon regardless of military experience.

Of course we defer to your expertise. Unfortunately, our medics and corpsmen are being given time to do their best. Wn route, the soldier is getting close to an advanced life support ambilance because transit time is transit time.

BUT, your emphasis on speed has been lost to process. The only folks fully equipped and ready to scoop as fast as possible in any situation are the AF Pedro crews. Our Army crews want that opportunity for speed, but there are too many risk averse decision makers intervening. It appears that was not the case in Iraq and it was not the case in RVN. And when a pilot from any service showed reluctance to get a casualty in RVN, it was so unusual that everyone heard about it. Ironically, those pilots or commanders were not afraid for themselves; they were focused on preserving the hardware.

To compound the stupidity, the Army and ISAF have built a wedding cake of bureaucratic layers composed of people who are subject matter ignorant. Michael tells us that in one coordination center, the man running it is an enlisted medic with no aviation or ground tactical experience, Hierarchically, he sits above Battle Captains, Battle NCOs, and AF coordination personnel sitting at Brigade and below. Normally, the “Battlespace owner” is the Brigade Commander. He and his staff ought to know what’s going on in their AO and should be able to allocate assets in that AO or request additional assets from higher when required. One serving officer told me that his Brigade Commander sent his personal Blackhawk to evacuate a critically injured soldier when nothing appropriate was available. That Commander is probably sitting atr the highest level capable of appreciating the real situation on the ground. Above that, they just have a rule book. Now add another layer of ignorance - ISAF bureaucracy. The wounded soldier clinging to life cannot benefit from their review of his commander’s 9-line request. This is a bureaucracy populated by risk-averse officers who lack both subject matter knowledge and local situation/threat appreciation. We tak about pushing decision-making and assets dow; but why did we ever let them be taken away?

The real question is who is feeding the JCS their data. I doubt their reply is original thought from the JCS level. It came from somewhere below, JCS staff or some other limp dick, and that is the individual that is feeding this crap to the JCS. Find that person, and hopefully the problem can be corrected. Right now the JCS are just parroting what the lower ranks are feeding them.........thoughts to ponder !!!

Why are the lives of those men in the field being lost to bureaucracy?? While the Army is adhering to a convention which, in conventional conflicts is a must, is being ignored by the very enemy they are fighting, lives of those brave men are being lost.

The BS of putting Red Crosses onto medevac aircraft to comply with the Geneva Convention when the enemy doesn't give one whit is asinine. Those rescue aircraft should be armed to protect themselves and their patients..

It's not about complying with the Geneva Conventions, it's way worse than one would wish to think. The only reason they are brought up is to get those responsible off the hook for what they're causing. Nowhere does the Geneva Conventions state that all MEDEVACs have to be unarmed and with a Red Cross on them. What they say is that MEDEVACs can't have weapons IF they have the Red Cross painted on them, and the Red Cross is not a requirement. The Red Cross just makes it illegal for signatorees to engage the helo, but the Talibans never showed up to sign, probably because [sarcasm] they're so very brave warriors of jihad [/sarcasm].

The root of the crime is probably a bunch of officers who want to keep "their" helos, the ones I think would be transfered to another branch within the Army if they were to be armed and start flying without Red Crosses.

According to Michael Yon, it would be better to let the Dustoff flight’s pilots and ground commanders decide on whether to complete extraction, or to wait for escort. He writes that Pedro and Dustoff pilots complain that Patient Evacuation Coordination Cell (PECC) procedure “tends to be risk averse to the point that troops die.” To me that is another proof that the JCS follows economically efficient operational guidelines and would rather have a soldier die than loose a MEDEVAC or a CASEVAC in a situation like that.It is not about incompetence or arrogance on the part of the US Armed Forces higher ranking officers looking down on the rank-and-file soldiers or, as one “Former Ranger and Green Beret” put it, “bureaucracy and parochialism and the egotistical protection of fiefdoms”. It is economy… From JCS’s point of view, it is business as usual, nothing personal.

The Medical Service Corps and their cadre of Commanders want to keep their ass(ets).

They deny our crews the operational leway to make the decision at the Unit Level and as noted by those expereinced Pilots flying DustOff their hands are tied by a poor decision making up their Chain of Command.

These Rear Echelon people are all about getting their tickets punched for their next promotion and not about getting the job done. DustOff flying when and where needed on a 5 minute skids up basis. The decision and responsibilty kept with the Pilot In Command.

Hopefully, this expose will draw the attention of the right beurocrats in Washington that happen to give a damn about the welfare of our troops and the JCS and Commanders down the line will be brought to task and things changed for the welfare of the men and women on the cutting edge.

Thanks Michael for sticking with this story! It is one that needs to be heard loud and clear by the American People and our Commander and Chief. It is past time that this issue be resolved.

Keep fighting the good fight Michael. This is good stuff and not the first time you've seen lives being put at risk for no apparent reason. Our friends in RC-W got most of what they wanted from the Spanish after you reported on their plight. I have contacts that saw it first hand after the fact, throughout 2011. This is obviously on a bigger scale, and even easier to remedy, it seems, since it is a US issue. I just hope the right thing is done, but remain sceptical.I'll be back in KAF this year, hope the TGIF is still open! Keep on keeping on!

When I came out with that classified stuff on RC-West, the milkooks of course went bonkers, but it may have saved Marine lives and aviators, too. It was the right thing to do, and a Colonel quietly thanked me. And I thank you for remembering. You can make a lot of enemies by doing the right thing. That's the breaks.

As a mother of 2 boys serving in the Army, Get the crosses/targets/bullseyes off the helicopters, arm them to the teeth, and let them do their jobs to get the wounded out of there ASAP. This shouldnt even be a matter of discussion...

100% agreed! The Army has had 62 years to do something about the Red Crosses (the Korean war was pretty much when it should have been understood that future enemies would not respect the Red Crosses). That equals tens of administrations that haven't put pressure on them, possible hundreds of generals (out of thousands, thank God they're a minority) have covered their behinds with lies, and the result is that thousands of American and allied servicemen can be assumed to have bled out waiting for a MEDEVAC that couldn't get there in time because it needed escorts, or even got shot down because it had no means of defending themselves against enemies who thanked their lucky star for those red markings that clearly indicated it was safe to come out and fire at the helo because it wouldn't fire back.

Makes me think of Edward Slovik, the Army Private who was executed in 1945 for refusing to go up to the front line. How come he gets shot for refusing to go to the front, when desk generals get away with thousands of soldiers dead because of petty rivalvry between them?

I totally agree with you, Armymum. This shouldn't even be a discussion and should have been remedied long, long ago when we went into Desert Storm and saw what we were facing with those who fail to even acknowledge that there is a Geneva Convention.

Or is this 59 of 60 min a total joke. Really? How many of these 55-59 min evacs have we had? We always add 5 min to our land time for taxi is that also added in?

Everyone in the flying community knows that its impossible for so many EVACS to be in that 30sec window. if they are that good at Shacking a sec TOT.... maybe they can do the same with a 30min window....

Michael I will disagree that PJ's are like Rangers. The Rangers are trained to work in fairly large , in the SF world, teams. Pj's and CCT's will work on ODA sized teams. PJ's Deploy with Tier 1 and 2 as a member of the ODA or a compliment. So I would compare them to an ODA member. Take Chapman on Takur Ghar, Cunningham, Also Wilkenson ( silver star Mogadishu) were all with SEAL, Delta, or ODA teams. ODA referring to Tier 2 SF teams

Prior to 2007, Army MEDEVACwas a MAJ subordinate command in theatre with a Medical Evacuation Bn controlling all sectors assets. Each Sector has a MEDEVACWAS Co of 15 UH/HH-60 airframes further broken into 4 MEDEVACWAS teams of a/c handling sub components of each sector. 9lines came into Co ops who dispatched the most mission appropriate team. We flew single ship in the beginning. PICs made tactical decision, Flight medics made medical decisions. We never dropped a mission, we're off the ground in less than 10 minutes and were typically at POI in less than 25. Patients were flown to the earnest appropriate MTF. We saved lives. Unfortunately, the Army decided that the a/c belonged in the division under their control, needed an escort to fly and other non doctrinal policies adding layers and layers of removing the medical decision from the Point of Injury. People died and continue to die. Armed escorts don't reduce the threat, they increase exposure to the threat. No armed escort suppresses the shoulder fired middle, RPG, IED on the road at pickup. I never had an armed escort suppress any of the ground fire I received. The JCS and the Generals who lobbied for ownership of the Command inferior MEDEVACWAS assets are strictly to blame. For decades the Medical Service Corps trained and refined DOCTRINES to get patients to ever increasing levels of medical care. The division policy changed that to Commanders with NO MEDEVACWAS training winging it and they continue to do so today. Mark K Morris MAJ, USA (Ret) former enlisted, warrant, and retired 67J MEDEVAC pilot with over 3500 hours and over 1000 hours in combat.

I don't even know how I finished up right here, but I assumed this put up used to be good. I do not realize who you might be however certainly you are going to a well-known blogger should you aren't already.Cheers!

Reader support is crucial to this mission. Weekly or monthly recurring ‘subscription’ based support is the best, though all are greatly appreciated. Recurring and one-time gifts are available through PayPal or Authorize.net.

To support using Venmo, send to:@Yon-Michael

My BitCoin QR Code

Use the QR code for BitCoin apps:

Or click the link below to help support the next dispatch with bitcoins: